“I am a man. Real men don’t get scared. I took the right decision,” proudly says Krishna Bahadur Chettri, 38, a rickshaw puller. He has two children and his wife was taking contraceptive pills. They were always scared of unwanted pregnancies. It was then ASHA worker convinced the couple that the husband could go for a vasectomy.
Chettri says, “I love my wife. I will feel bad if my wife is operated upon. Therefore, I decided to take the plunge.” He is grateful to the ASHA worker for helping them take a decision that made their life easier. “I respect our ASHA baideo as she is responsible for the sound health of everyone in the village.”
Dipak Bora, 42, who runs a shop at Harigaon, near Paruwa in Assam’s Sonitpur district has two children. His wife had put in a Copper T and was suffering from some complications. She got it removed. Moreover, she was anaemic. Then there was this constant fear that she might conceive. It was then that the ASHA worker convinced the couple that the best way out would be to go for a vasectomy. He says, “I decided to go for vasectomy. I am thankful to ASHA baideo (sister) for showing me the way. It was the least I could do to relieve my wife’s suffering.” Bora is now a role model for the ASHA workers. They use his example to convince others.
ASHA workers have a tough time convincing men to go for a vasectomy. However, a dedicated team led by ASHA supervisor Himani Deka is working wonders in the Balipara Sub-centre in Assam’s Sonitpur district. And their rates of successful vasectomies is impressive — in 2015-16, they conducted 170 vasectomies in Balipara Block and in 2016-17, 209 vasectomies have been done till date. In undivided Sonitpur district, there has been 555 vasectomies from April 2016 to January 2017.
Himani Deka works with 12 ASHA’s in 12 villages under her. “In 2009, when I had first started we should used to walk around fields, talk to people. It was very difficult to convince them. Hardly 5-6 people turned up. Now, we have more than 30 to 50 people turning up for our vasectomy camps. We hold meetings every Wednesday in villages,” she says.
Indeed, their efforts has not been without pitfalls. “There had been instances when men have run away from the operation table. But we manage to convince them and they come back. I have seen it is difficult to convince educated people. It is the people at the grassroots who are more eager and who heed to our advice.”
We tell them that they will recover after 2-3 days rest. There is no problem and their virility will not be affected,” says Deka. Deka agrees that cases of tubectomy is definitely more than vasectomy. If we get 20-25 people we hold a camp at Balipara PHC.
Deka’s team usually go in a group – the ASHA worker and the supervisor. “It’s difficult to explain alone. It is usually through home visits, explain to the couple and start with the wife. Usually it doesn’t happen on the first visit. We wait for them to respond. We ask the wife to convince her husband,” says Deka.
Kamala Bora, an ASHA of Harigaon Dakhin Khanda cited one instance when the mother convinced her son to go for vasectomy and save her daughter-in-law the pain. However, she had a nasty experience once when she asked a man to go for vasectomy. He gave her an indecent proposal that rattled her.
Men usually feel shy to come and talk about their experience to others in the community. It is difficult to make them official role models. Psychiatrist Dr Nahid Islam agrees that there are many misconceptions associated with vasectomy due to lack of awareness. “Men give lot of importance to their manhood and virility. They feel that if they lose their potency, they will lose their social position as a man. It is usually thrust on the woman as she bears the child.” Vasectomy camps help to convince them. Since it is a sensitive issue as it is related to their self-esteem, the role of the ASHA workers is paramount. Proper education, awareness and scientific temperament is important,” she says.
Pulakesh Bora, District Family Planning Co-ordinator feels that post-counselling is equally important. “Our team does constant follow-ups till 10 days after vasectomy is done. We also try to address their fears and give them psychological support. Our complications are minimal and we try to ensure that there is no negative fall-out,” he added.
Dr Ilias Ali, the nodal officer for no-scalpel vasectomy (NSV) in Assam says, “Assam has come a long way from just 16 cases of male sterilisation in 2008 to over 40,000 between 2009 and 2013.” NSV is a minimal invasive method of birth control, which is hassle-free, painless and quick. It requires making a single hole in the scrotum and blocking two sperm-carrying tubes, a task which can be achieved in less than 10 minutes. What makes it even more acceptable and popular is that it is can be reversed for those who wish to be fathers’ again.
Many ASHA workers, who hail from the same locality cite their own experiences to convince the couples. Anima Boro, ASHA worker told couples that she herself has five kids. “There was nobody to tell me about contraceptives. I got a tubectomy done only after five children. Now I realise my folly and hence convince other women not to repeat my mistake.” Boro convinces the women that regular and prolonged intake of birth control bills might also be harmful.
Nowadays Boro feels that there is a sea change. Couples approach us after their first child. We ask them to wait as it is against the norms. “Nowadays everyone wants to send their kids to English-medium schools. We tell them that they will not be able to able to afford the comforts of life if they have too many kids. I give them my own example,” says Boro.
Government gives incentives for every vasectomy done. A couple gets Rs 2000 if they get a vasectomy done. Earlier they used to give cash. Now, the amount is transferred into bank accounts. It’s difficult for people without bank accounts to survive. Initially they were given Rs 600, which was raised to Rs 1100 and now Rs 2000. ASHA workers used to get Rs 500 per vasectomy which has now come down to Rs 200. ASHA workers get a fixed stipend of Rs 1000 per month.
The selection of an ASHA is a rigorous process. A 15-member committee consisting of ward members, teacher, anganwadi members and ANM all sit and decide the ASHA. Shrikumari devi, is an ASHA worker in No 2, Parmaigukli Paruwa sub-centre under Balipara PHC. She works in two villages with over 800 population comprising mostly people from the Bihari community. She has four daughters and is separated from her abusive husband. My husband used to beat me when I had to move out late at night with the expectant mothers. She shows the marks on her hands. He used to beat me with whatever he could grab his hand on. Now, she lives with her parents and her four daughters. “My parents tell me don’t go out at night. You still look young. Somebody might abuse you. I tell them that my work is important,” she says. She started working from 2010 and has been able to get 60 vasectomies done till date.
The ASHA workers enjoy the respect they get because of their profession. Padma Tanti, ASHA of Noorbarie Tea Estate said, “When we go around the villages, small kids run around and say ASHA baideo has come. Polio baideo has come. We feel important as we are recognised by doctors and nurses in the hospitals. We feel a sense of self-worth.” She and her colleagues enjoy the regular trainings that they have to undergo which also involves role play and innovative ways to motivate people.
Tanti is wiser now. She realises how it is important to build a rapport with everyone. “Whenever we go for home visits, we make it a point to atleast drink a glass of water. This helps in breaking the ice.” And she knows she has an important task in hand.